How to Thrive in Professional Practice. Stephen J Mordue

a clothesline’. This fascinating phrase comes from the days of the workhouses of early twentieth century London where people who were homeless and couldn’t afford the price of a bed for the night had made available to them a bench to sit on and a clothes line to lean over in order to sleep. Many people are less fortunate than me, however, and have problems with sleep. Matthew Walker (2018), drawing on his 20-year research career into sleep, suggests half of us are not getting as much sleep as we need. For most people who fall into the ‘not sleeping well’ category I’d imagine you are going to bed feeling tired and are unable to get to sleep because of what I refer to as the ‘churn’ of the day’s activities. Or you may be thinking about tomorrow’s tasks and have them going around and around in your head keeping you awake. ‘Open loops’, as David Allen (2015) refers to them. Things that you don’t have recorded anywhere that you are trying to hang on to and remember. For me, having a ‘trusted system’ as outlined in the productivity chapter (Chapter 7) can help me to manage this to a large extent by knowing everything is captured, nothing is forgotten, and it’s all just waiting there in an organised format, for me to get to it the next day. There are other people who fall asleep without problem but wake up in the early hours of the morning only to start to ‘churn’. When I’ve got a lot going on this is what happens to me. I find some sort of mantra-like mindfulness exercise can help. I repeat ‘there’s nothing to be done now, this is my time’ over and over again until I drop off. It’s a bit like counting sheep. (More on mindfulness in Chapter 5.)

      Think about how you sleep

       What time do you usually go to bed?

       What time do you usually get up?

       Do you find it difficult to get to sleep?

       Do you wake up during the night?

       How do you feel when you wake up the next morning?

       Do you usually wake up naturally or does the alarm clock always wake you? Do you sleep differently on a weekend?

      What is sleep?

      In his lectures about dreams in 1915 Sigmund Freud asked the question ‘What is sleep?’ and suggested that:

      Sleep is a state in which I want to know nothing of the external world, in which I have taken my interest away from it. I put myself to sleep by withdrawing from the external world and keeping its stimuli away from me. I also go to sleep when I am fatigued by it. So when I go to sleep I say to the external world: ‘Leave me in peace: I want to go to sleep.’

      (Freud, 1991 [1915], p 117)

      Here Freud tells us, very simply, a few truths I feel are worthy of note. He talks about a state in which you have taken your interest away from the external world. I’ve already mentioned that what stops us getting to sleep is our attention on the external world, so we need to consider how we take our attention away from it in order to achieve rest. He also makes going to sleep a very personal responsibility. When I talk to people about self-care there is often a backlash, with people telling me, no matter what solutions I propose, that the problem is their workload or the nature of the work and is not about them wanting to disengage from it. I understand and accept this argument; however, I don’t wholly agree with it. There are ways we can achieve distance, a ‘settledness’ about how we have left our work, in order to give us the space to engage in rest and recuperation, of which sleep is one part. Only the individual can take such actions. Many people work in stressful jobs and a proportion of them sleep well. So, while the job undoubtedly has an impact, and I am not denying workplace stress, I’m a great believer in doing something in the areas you can take responsibility for. My philosophy here is that I’m trying to be part of a solution rather than part of the problem. Only you can take action to work towards good sleep and good self-care, while you and others continue to make the case for organisational change around the other realities of professional practice.

      Freud also talks about keeping the world’s stimuli away. This proves so difficult with late night television, emails, smartphones and more. Part of having a good night’s sleep is looking at how you prepare for sleep. There is compelling evidence that the light from our ‘always-on’ devices stimulates our brains and overturns the chemical process going on internally to facilitate sleep. The blue light (traditionally the sky when we were outdoors more) that sends an ‘it’s daytime’ message to our brains is evident in such devices and has a negative impact on melatonin release essential for sleep. It has been discovered that melatonin release can be suppressed for 90 minutes after exposure to bright light (Webb, 2017). The number of people with sleep problems is increasing and for many it is the exposure to these bright artificial light sources that could be causing the problem. Exposure to a light level of 10,000 lux, which is approximately equal to being outside on a clear day, was shown to increase the length of time it took people to get to sleep in a Japanese study (Nakamura et al, 2019).

      Getting to sleep

      The desire to sleep is driven by the pineal gland’s production of melatonin in your brain; the gland reacts to diminishing light by flooding your brain, making you feel sleepy and less alert. Melatonin starts to increase at around 9pm, then stays in your brain through the night for about 12 hours. It begins to fall to low levels when daylight seeps through your eyelids, ‘instructing’ the pineal gland to stop its production of melatonin, with levels being at their lowest around 9am. This cycle goes on in your body over a near to 24-hour cycle irrespective of what you are trying to push your body to do. In fact, this process is so chemically locked in that even in the absence of light the body continues this cycle.

      Over 80 years ago in 1938, Professor Nathaniel Kleitman and his research assistant Bruce Richardson from the University of Chicago became their very own research project. They took a trip to Kentucky and entered Mammoth Cave with enough supplies to last them six weeks. Mammoth Cave is one of the deepest caves on the planet, so no light penetrates its depths. In the cave they set about living in darkness to see what happened. Their work established that we have a biological, circadian rhythm of about 24 hours, and it showed that in the absence of the external stimuli of light we do not descend into a chaotic random sequence of waking and sleeping. They discovered that they were awake for about 15 hours and then asleep for about nine hours. Does that sound familiar? They did, though, find that the human ‘rhythm’ is not precisely 24 hours. Later research building on their own showed that on average, if left alone, we work on a ‘clock’ of about 24 hours and 15 minutes. Thankfully, our in-built chemistry and our pineal gland keep us on track by utilising our reaction to light and dark and working alongside other factors such as a drop in core body temperature to get us to sleep. This gives us some clues to the ideal sleep pattern we are searching for.

      Quantity and quality

      The World Health Organization and the National Sleep Foundation tell us something I suspect you already know. We should be aiming for about eight hours of sleep per night. Certainly, we should be within the region of seven to nine hours. The World Health Organization has stated that sleep loss is now an epidemic in the industrial world and Walker (2018) states that:

      Routinely sleeping less than six or seven hours a night demolishes your immune system, more than doubling your risk of cancer. Insufficient sleep is a key lifestyle factor determining whether or not you develop Alzheimer’s disease. Inadequate sleep – even moderate reduction for just one week – disrupts blood sugar levels so profoundly that you would be classified as pre-diabetic…

      (Walker, 2018, p 3)

      A lack of sleep doesn’t only affect your physical health; it also takes effect on your mental state. It can make you sluggish, prone to poor decision making and procrastination, and can impact on creative problem solving (Tuck, 2018). In professional practice clear decision making and effective problem